Arthritis of the

Knee, Hip and Shoulder

Michael W. Schweppe, M.D.Orthopedic Associates of Dutchess County

Chief of Orthopedics, Northern Dutchess Hospital

Anatomy of the Knee, Hip and Shoulder

Types of Arthritis

Diagnosis of Arthritis

Treatment Options

Topics

The Knee

Femur

Anatomy of the Knee

Bone View

Patella

Tibia

Medial ColateralLigament (MCL)

Anatomy of the Knee

Ligaments

Lateral Colateral

Ligament (LCL)

Anterior and Posterior Cruciate Ligaments

(ACL and PCL)

Radiographic Anatomy of the Knee

X-Ray View

Femur (Thighbone)

Patella (Kneecap)

Tibia (Shinbone)

The Hip

Pelvis

Anatomy of the Hip

Bone View

Femur

Anatomy of the Hip

Bone View

Acetabulum

(Hip Socket)

Femoral Head

(Hip Ball)

Radiographic Anatomy of the Hip

X-Ray View

Acetabulum (Socket)

Femoral Head (Ball)

The Shoulder

Anatomy of the Shoulder

Bone View

Glenoid

Humeral Head

Radiographic Anatomy of the Shoulder

X-Ray View

Humeral Head (Ball)

Glenoid (Socket)

Cartilage

Rubbery tissue found in joints

Cushions and protects the

ends of bones

Provides smooth gliding

surface for bones

Cartilage

Cartilage

Anatomy of the Knee

Anatomy of the Hip

Cartilage

Anatomy of the Shoulder

Cartilage

Arthritis

Affects 43 million

Americans each year

Over 100 different types

Defined as inflammation

of the joint

Arthritis

Osteoarthritis

Rheumatoid arthritis

Two Primary Types of Arthritis

Rheumatoid Arthritis

Affects about 2.5 million Americans annually

Physically disabling disease

Medical disabling disease

Rheumatoid Arthritis

An autoimmune disorder

Usually affects more than one joint at a time

Inflammatory joint condition

Joint’s lubricating fluid increases pressure inside joint

Synovium thickens

Erode the cartilage

What is Rheumatoid Arthritis?

Osteoarthritis

Affects 23 million Americans

10x more common then RA

Less physically disabling disease

Not typically medical disabling disease

Osteoarthritis

What is Osteoarthritis?

Not an autoimmune disorder

Degenerative disease

Usually affects ONE joint at a time

Degenerative joint condition

Wear and tear

Knee Osteoarthritis: Disease

Progression• Early-stage: Mild disease

● Minimal pain

● Sports related injuries

● Minor defects/ loss of cartilage

• Mid-stage: Moderate disease● Increased or moderate pain

● Reduced mobility

● Changes to lifestyle/sports activities

● Moderate cartilage defects

● One or two compartments

• Late-stage: Severe disease● Severe pain

● Leading cause of disability

● Walking, stair climbing challenging

● Severe cartilage loss and limb deformity

● All three compartments

Knee Osteoarthritis: Radiographic

Grades

Normal or Early Stage Mild or Moderated

Late or Severe

Knee Osteoarthritis: Causes

• Injury or Trauma

• Sports

• MVA

• Long Term activities

• Running controversial

• Obesity

• Joint Reactive Forces

• 1 lbs. = 7 lbs. knee

• Heredity

• Known causes

• Unknown causes

Diagnosis

History

Symptoms

Physical Exam

X-Rays

Blood Tests

Diagnosing Osteoarthritis

Symptoms of Arthritis

Pain

Joint Swelling

Stiffness

Decreased activity

Impaired lifestyle

Decreased range of

motion

Tenderness

Joint deformities

Swelling

Crepitus

Physical Examination

X-Ray Analysis

Normal Knee X-Ray Arthritic Knee X-Ray

X-Ray Analysis

Normal Hip X-ray Arthritic Hip X-ray

X-Ray Analysis

Normal Shoulder

X-Ray

Arthritic Shoulder

X-Ray

Treatment

Options

Weight Loss Home Exercise Physical Therapy Ice Medication Dietary supplements Walking devices Braces Injections Surgery

Treatment Options

Excess weight places

Excess pressure on joints

Causes osteoarthritis

Aggravate osteoarthritis

Lower extremity not upper

Diet/Weight Loss

Low Impact

Improves joint mobility

Strengthen muscles

Provides support for joints

Exercise/Physical Therapy

High Impact

Exercise/Physical Therapy

Decreases inflammation

Decreases swelling

Decreases pain

Ice

Tylenol/Acetaminophen

Anti-Inflammatory Medications

Ibuprofen

Aleve

Naprosyn

Celebrex

Relafen

Medication

Chondroitin Sulfate

Glucosamine Sulfate

Dietary Supplements

Braces

Multiple types

Help re-align joints

Compression

Braces

Walking Devices

Cane

Walker

Helps reduce pressure

Walking Device

Cortisone (Steroid)

Decreases inflammation

Viscosupplimentation

Synvisc

Hyalgan

Injections

Ultrasound-Guided Injections

Arthroscopic

Debridement

Joint Replacement

Surgery

Knee Osteoarthritis: Surgical

Treatment OptionsArthroscopic Surgery

• Early OA

• Repair uncommon

• Mild- Mod OA

• Debridement

• Variable benefits

• Severe OA

• Contraindicated

Pain negatively affects daily

living

Conservative options failed

Extensive cartilage damage

Joint deformity

When Should Total Joint

Replacement be Considered?

Eliminate or reduce pain

Enhance mobility

Can improve quality of life

Return to normal activity

Low impact sports and activities

Benefits of Total Joint Replacement

Damaged bone resurfaced

Components made

metal alloy

Polyethylene

Total Knee Replacement

Total Knee Replacement

Primary Knee Components

Femoral Component

Polyethylene Bearing

(Acts as cartilage)

Tibial Tray

(supports polyethylene bearing)

“MIS”Arthroscopy

Early Stage Sports Injuries Early to mid-stage OA Late stage OA

Total Knee Arthroplasty

(TKA)Partial (Uni) Knee Arthroplasty

Knee Osteoarthritis: Traditional

Treatment

Total Hip Replacement

Shell

Liner

Head

Stem

Hip Implants

Primary Shoulder Components

Humeral Head Polyethylene

Glenoid

Component

Stem

Total Shoulder Replacement

Hospital stay approximately 1-2 nights

Assisted walking within 24 hours

Pain medication

Physical therapy

Key to recovery

Help prevent swelling,stiffness, and pain

Regain strength and mobility

Joint Replacement Surgery

2-4 weeks of discomfort

Physical Therapy for 4-

6 weeks

Home exercise program

as directed by physician

Recovery

Routine Activities

2-4 weeks

Walking (un-assisted)

Driving

Gardening

Shopping

Housework

Resume Usual Activities

Low-Impact Activities

1-2 months

Golfing

Dancing

Bowling

Swimming

Bicycling

Work

Resume Usual Activities

Recent Advances in

Joint Replacement

Minimally Invasive 4 to 5 inch incision

Shorter and less painful recovery

Alternative Materials

Polyethylene

Ceramic Partial Knee Replacement

Customized Patient-Specific Surgical Instruments

Your symptoms should be diagnosed to

help you get relief

There are many different treatment

options

Osteoarthritis and rheumatoid arthritis

are treatable, manageable conditions

Closing

Thank You